Quetta: In Balochistan, giving birth is a near-death experience.
The absence of maternal health services, populations scattered over vast distances in far-flung areas and cultural taboos that keep women in labour away from doctors has seen 785 new mothers die for every 100,000 deliveries.
That rate, recorded in the 2012 Maternal Neonatal and Child Health report 2012, is two and half times the nationwide maternal mortality rate for the same year, which saw 297 mothers die for every 100,000 deliveries.
Balochistan’s rate is nearly four times the global maternal mortality rate of 216 per 100,000, according to UNICEF figures for 2015. Only Nigeria, Sierra Leone and South Sudan have a higher rate than Balochistan, the UNICEF data on maternal and child health shows. Neighbouring Afghanistan had a rate of 396 per 100,000 in 2015, while India’s rate was 174 per 100,000.
Saddiqa, 45, suffered the harshest experience of her life when she gave birth for the 11th time. Her twins were still-born. She had suffered exhaustion and fever during her pregnancy, but she received no medical attention.
“I had felt weak the whole year. I had fever in my body. Dizziness would push me down to earth. No one took care. My weakness would have affected the health of my unborn children,” she told News Lens.
Like Saddiqa thousands of women across Balochistan experience the toughest phase of their life when they are pregnant. Culturally, however, taking pregnant women to doctors is considered a waste of money and a mark of dishonour. Birth and death should take place at home, according to rigid tradition.
If expectant mothers are brought to hospital, entire extended families travel to the hospital, as it is a sign that the mother is at risk of dying. Maternity ward corridors are crowded with relatives.
At the Civil Hospital in provincial capital Quetta, poor people clad in traditional Pashtun and Baloch robes with infants on their laps rest on blankets with small pillows. They have made the foyer of the maternity ward their second home, while they wait for relatives going through labour.
“Our people have no entertainment other than giving birth,” Jamil Kakar, who was waiting for his sister in law in the maternity home, joked.
The hospital handles several pregnancy cases each day. Women have given birth even in rickshaw on their way to the hospital.
“We have followed the slogan to ‘increase the number of Ummah’ (Muslim population) but we never care for our women and the babies’ future,” Kakar said.
Balochistan’s Health Minister Rehmat Saleh Baloch believes the maternal mortality rate has improved since 2012, though there is no updated data.
Immunization coverage has increased to 64 per cent from 16 per cent, he said.
“In Gawadar, Panjgur, Washok and the rest of the province, no district hospital could do caesarean deliveries for the last 25 years. But we have now provided both specialized doctors and functional maternity homes to every district hospital,” the minister told News Lens.
But there are no doctors on call, no maternity homes, and nowhere for doctors to stay if they make house calls in far flung areas like Kohlu and Sibbi. In such area there are no expert Lady Health Workers to handle deliveries.
“No one treats pregnancy cases. The government runs advertisements but nothing exists on the ground,” senior gynaecologist Doctor Sajidda Marri told News Lens.
The government has no proper plan for awareness, nutrition, ambulances, punctuality of the gynecology units and maternity homes in far flung areas, she said,
“Low incomes force people to consult dahis (traditional healers) and old women instead of gynecologists, doctors and lady health workers,” Marri added.
“Earlier, international organizations played an active role in providing services for women, especially maternal health services, and in compiling health data. However a ban on these organizations forced them to leave the province.”
The minister believes the violent insurgency that has seen multiple deadly bomb attacks in and around Quetta over the past decade has pushed many skilled gynaecologists to leave the province and move to Saudi Arabia, Oman, and the United Arab Emirates.
“We have only around 47 specialist doctors in the whole province. There are 300 gynaecology positions vacant,” he said.
Many women giving birth die when unskilled dahis handle their deliveries at home. The mothers are only shifted to hospital when they are on the verge of dying, and they breathe their last in their hospital bed.
Most district hospitals are without gynaecologists. Those which have gynaecologists rarely send them to remote areas for deliveries because they are needed at the hospitals to keep the maternity wards functioning, says Ghazala Bashir, a senior Lady Health Worker from Chaman, the frontier town straddling the border with Afghanistan.
“Excessive bleeding, lack of health services, lack of awareness of how to handle pregnancies in hospitals, and the lack of nutrients and food are the reasons for our high maternal mortality rate,” Ghazala told News Lens.
“Chaman has a population of over one million, yet only 13 practicing Lady Health workers. They cannot cover every delivery case. Hence many women lose their lives while being treated by dahis,” she said.
The health ministry funds a community-based midwife program for 1,200 midwives, training and equipping 900 of them. Of these 400 are deployed to provide “nutrition” to pregnant mothers, the minister said.
Hayatho Bibi, 70, is one of the traditional healers in Chaman.
“The majority of people are asking for my services instead of a doctor’s service, because they are not ready to let their wives leave the home to give birth,” Bibi told News Lens Pakistan.
Saddiqa is resigned to suffering in bearing children.
“Whenever I tell my husband that I need proper care, he replies: ‘God takes care of everything, including your health and children.’ So, I stop asking and mentally prepare myself for misery,” she says.
“God know whether I would survive another delivery.”